Please Take A 2-3 Minutes To Fill Out This Quick Questionnaire…

We will use this information to determine if we can help. We will also be able to provide you with some tailored training material based on your responses.

JOIN THE ELITE PHYSIQUES COMMUNITY

Gain special entry to our private Facebook Group, a space where you can interact directly with me, ask questions about the app, share your personal fitness story, and engage with a community of individuals who share the same goals

JOIN THE COMMUNITY

*ONLY fill out the questionnaire if you are serious and ready to make a change RIGHT NOW!

What's your full name? *

Age *

What's your email? *

What's the best number to reach you at? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Are you located in the US or Canada? *

Yes

No

What's your Instagram username? *

What's your job title? (This will give us an idea of how active you are at work.) *

Gender *

Male

Female

[W] Using the body fat percentage chart provided above as a reference, Make an honest assessment of your current body fat percentage. (Select the range that you feel most accurately represents your current state.) *

Using the body fat percentage chart provided above as a reference, Make an honest assessment of your current body fat percentage. (Select the range that you feel most accurately represents your current state.) *

What's your height? (feet) *

What's your current weight? (pounds) *

Do you have any current or past injuries? *

Yes

No

Please explain Injury or injuries *

Do you have a current photo of yourself you can upload? This will help us assess your current shape. (Your photos are protected and confidential.) *

Yes

Not right now

Please attach a FRONT OR SIDE photo of your current physique. (Your photos are protected and confidential.) *

Please attach a FRONT PHOTO of your current physique. (Your photos are protected and confidential.)

Provide a REALISTIC full day of eating, including beverages and supplements. *

How often do you eat out each week? *

1-2x

3-4x

5-6x

7x+

What do you usually eat when you go out for food? (Include restaurant names) *

Do you find yourself falling off track on the weekends? *

Yes

No

Do you drink alcohol regularly? *

Yes

No

How often and how much? *

What are your short-term (12-16 week) goals? Paint the picture for me. *

What are the top 3 challenges preventing you from reaching these goals (please explain in detail) *

How long have you been struggling with these challenges? *

What have you tried in the past to solve these problems but have ultimately failed? *

WHY is it important for you to make these changes TODAY? *

When would you like to start your program? *

Our coaching program is not a cheap "cookie-cutter" program. It's a hands-on, 1-on-1 coaching program tailored to your specific goals and needs. Why do you want to work with us? *

The program requires a minimum 12-week commitment and a one-time investment. Our goal is to equip you with the knowledge and tools you need to achieve your goals with confidence and ease. So by the end of the program, you will have developed new habits and acquired valuable knowledge that will help you to continue your fitness journey on your own. With that in mind, we would like to know: how much would you be willing to invest per month over the next 12 weeks if you were certain that our program could help you achieve your goals? *

$200-300/month

$400-500/month

$600-700/month

Whatever it takes

Aside from you, does anyone else need to be involved in this investment decision? *

Yes

No

Tell me something non-health/fitness related about yourself? *

Please Take A 2-3 Minutes To Fill Out This Quick Questionnaire…

We will use this information to determine if we can help. We will also be able to provide you with some tailored training material based on your responses.

JOIN THE ELITE PHYSIQUES COMMUNITY

*ONLY fill out the questionnaire if you are serious and ready to make a change RIGHT NOW!

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